# A client who has taken alprazolam 0.5 mg PO three times daily for 6 months tells the nurse she would like to stop the medication today because she feels better. Which response is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391723&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A client who has taken alprazolam 0.5 mg PO three times daily for 6 months tells the nurse she would like to stop the medication today because she feels better. Which response is most appropriate?

## Option

1. "You must continue this medication for the rest of your life once started."
2. "Switch to taking it only as needed instead of stopping it completely."
3. "Stopping suddenly can cause withdrawal seizures, so the provider will taper the dose gradually." **✔ Correct answer**
4. "That is great progress; you may stop the medication today."

**Correct answer: 3**

## Explanation

Correct (3): Abrupt discontinuation of a short-half-life benzodiazepine like alprazolam after prolonged use can precipitate withdrawal seizures, rebound anxiety, autonomic instability, and severe insomnia. Standard practice is a slow taper (commonly 25% per week or slower) directed by the prescriber. (1) Incorrect — abrupt stopping is dangerous after 6 months of regular use. (2) Incorrect — lifelong use is not required; safe discontinuation is possible with appropriate taper. (4) Incorrect — switching to PRN does not address established physiologic dependence and can still trigger withdrawal.

## In-depth explanation

Memory Tip Short-acting benzodiazepine (alprazolam, lorazepam, triazolam) + abrupt stop = withdrawal seizure. Patient Teaching Never run out without an active refill plan; report rebound symptoms (anxiety, tremor, insomnia) immediately rather than self-medicating.

## Clinical scenario

Scenario A 42-year-old female with generalized anxiety disorder has been on alprazolam 0.5 mg PO TID for 6 months. She reports symptom resolution and asks to stop the medication during today's outpatient visit. No acute symptoms are present.

## Key concepts

- **Benzodiazepine dependence** — Physiologic adaptation to benzodiazepines after weeks to months of continuous use; abrupt cessation produces withdrawal symptoms including seizures, autonomic hyperactivity, and rebound anxiety.
- **Discontinuation taper** — A structured dose reduction schedule (commonly 25% per week or slower) used to safely discontinue long-term benzodiazepine therapy and prevent withdrawal seizures.
- **Rebound anxiety** — Return of anxiety symptoms more intense than baseline shortly after stopping a short-acting benzodiazepine; can mimic the underlying disorder and confuse assessment.

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